India’s Cough Syrup Crisis: Deadly Medicines and a Weak Drug Oversight System
It’s a tragedy that keeps repeating itself in India.
In early September, a small town in Madhya Pradesh was shaken by the sudden deaths of several children. Within weeks, at least 19 children aged between one and six had died after consuming a common cough syrup. Health officials initially suspected contaminated water, mosquito bites, or food poisoning. The real cause was far more horrifying — their kidneys had failed.
Weeks later, a state laboratory in Chennai confirmed the shocking truth: the syrup contained 48.6% diethylene glycol, a toxic industrial solvent that should never be present in medicine. The compound, commonly used in antifreeze, is lethal when ingested, leading to acute kidney failure.
A Familiar Tragedy
This wasn’t an isolated case. In Rajasthan, two more children died allegedly after consuming a locally manufactured Dextromethorphan syrup, a cough suppressant considered unsafe for very young children.
For India, the news brought back painful memories. Over the years, tainted cough syrups have repeatedly caused mass child deaths — both domestically and abroad.
-
In 2023, diethylene glycol-contaminated Indian syrups were linked to the deaths of 70 children in The Gambia and 18 in Uzbekistan.
-
Between 2019 and 2020, at least 12 children died in Jammu, India, from contaminated cough syrup.
-
Decades earlier, similar poisonings had claimed lives across the country.
Each time, regulators vowed to tighten safety measures. Each time, the problem returned.
A Broken Regulatory System
Experts say these recurring tragedies reflect the deep flaws in India’s pharmaceutical oversight system. The country’s vast, fragmented drug market includes thousands of small-scale manufacturers, many operating without stringent quality checks.
Even as India’s cough syrup market grows rapidly — projected to surge from $262.5 million in 2024 to $743 million by 2035 — safety concerns persist. Regulators often struggle to enforce standards or recall dangerous products quickly enough.
After the most recent deaths, the Ministry of Health issued an urgent advisory calling for the “rational use” of cough syrups, suspended the sale of the tainted batch, and launched an investigation. But critics say these measures fail to address the root cause: weak enforcement and over-prescription.
Why Cough Syrups Are Overused
Cough syrups are widely seen in India as a quick fix for sore throats, allergies, and viral coughs. Marketed as soothing relief, they typically combine sugar, coloring agents, and a mix of antihistamines, decongestants, and expectorants.
However, doctors say that most coughs — especially in children — are viral and self-limiting, resolving naturally within a week. According to pediatricians, syrups rarely speed recovery and often come with serious risks, including toxicity, dependency, and accidental overdose.
Dr. Rajaram D. Khare, a pediatrician in Mumbai, explains:
“Most childhood coughs are allergic or viral. I only prescribe syrups occasionally for comfort — never as a cure. The real goal is relief, not treatment.”
Pollution, Allergies, and Misdiagnosis
In India’s increasingly polluted cities, most children’s coughs are caused by airborne allergens and smog, not infections. These coughs respond best to bronchodilators — medicines that open the airways — usually through inhalers or nebulizers.
But many doctors continue to prescribe syrup-based remedies that offer little benefit. Worse, some formulations can be dangerous for infants who cannot clear mucus from their lungs, increasing the risk of pneumonia.
Rural India: The Heart of the Problem
The crisis is even more pronounced in rural areas. In many parts of India, up to 75% of primary care is provided by informal practitioners, or “RMPs,” who often lack formal medical training.
With public health clinics frequently understaffed or closed, villagers rely on these self-taught practitioners — or even shopkeepers — for medical advice. Cough syrups, being inexpensive and easy to sell, have become their go-to solution for nearly every ailment.
Dr. Kafeel Khan, a pediatrician who once worked in Uttar Pradesh, recalls:
“When I was in Gorakhpur, I saw syrups being handed out everywhere — even by people with no medical degree.”
Dinesh Thakur, a former pharmaceutical executive turned public health advocate, adds:
“People often assume that the person behind the pharmacy counter is a qualified pharmacist. In most rural areas, that’s almost never true.”
He points out that while rural regions suffer most from poor-quality drugs, even urban areas are not immune. “The only difference,” he says, “is that the quality of supply in small towns is significantly worse.”
Parental Pressure and Medical Gaps
Doctors also cite parental anxiety and gaps in medical education as major contributors. Parents, desperate to see quick results, often push doctors to prescribe syrup-based treatments.
“If a cough doesn’t improve in two or three days, they go to another doctor who will definitely prescribe a syrup,” says Dr. Khan. “Even MD pediatricians sometimes misuse drugs like ambroxol, which can be harmful for children under two.”
Repeated Warnings, Little Change
Despite repeated tragedies, India has yet to establish a strong national policy regulating the sale and use of pediatric cough syrups. The lack of a centralized database for tracking adverse drug reactions makes it even harder to prevent repeat incidents.
Meanwhile, the global damage to India’s pharmaceutical reputation continues. Once celebrated as the “pharmacy of the developing world,” India now faces growing scrutiny from international health regulators after multiple export-linked deaths.
The Way Forward
Experts say reform must begin with stricter regulation, better training for doctors, and stronger awareness among parents. Quality testing must be made mandatory at all stages of production, and small-scale manufacturers should face regular audits.
Public education campaigns can also help. As Dr. Khare notes:
“We need to teach parents that most coughs don’t need medicine — they just need time and care.”
Until India confronts its overreliance on cough syrups and enforces stricter pharmaceutical standards, tragedies like Madhya Pradesh will keep returning — claiming the youngest and most vulnerable lives.